Category: Nevin Manimala

Ann Surg. 2023 Jul 3. doi: 10.1097/SLA.0000000000005983. Online ahead of print.

ABSTRACT

OBJECTIVE: To characterize hospital-level professional networks of physicians caring for older trauma patients as a function of trauma patient age distribution.

SUMMARY BACKGROUND DATA: The causal factors associated with between-hospital variation in geriatric trauma outcomes are poorly understood. Variation in physician practice patterns reflected by differences in professional networks might contribute to hospital-level differences in outcomes for older trauma patients.

METHODS: This is a population-based, cross-sectional study of injured older adults (age ≥65) and their physicians from January 1, 2014-December 31, 2015, using Healthcare Cost and Utilization Project inpatient data and Medicare claims from 158 hospitals in Florida. We used social network analyses to characterize hospitals in terms of network density, cohesion, small-worldness, and heterogeneity, then used bivariate statistics to assess the relationship between network characteristics and hospital-level proportion of trauma patients who were age ≥65.

RESULTS: We identified 107,713 older trauma patients and 169,282 patient-physician dyads. The hospital-level proportion of trauma patients who were age ≥65 ranged from 21.5% to 89.1%. Network density, cohesion, and small-worldness in physician networks were positively correlated with hospital geriatric trauma proportions (R=0.29, P<0.001; R =0.16, P=0.048; and R =0.19, P<0.001, respectively). Network heterogeneity was negatively correlated with geriatric trauma proportion (R=0.40, P<0.001).

CONCLUSIONS: Characteristics of professional networks among physicians caring for injured older adults are associated with the hospital-level proportion of trauma patients who are older, indicating differences in practice patterns at hospitals with older trauma populations. Associations between inter-specialty collaboration and patient outcomes should be explored as an opportunity to improve treatment of injured older adults.

PMID:37389887 | DOI:10.1097/SLA.0000000000005983

JAMA Netw Open. 2023 Jun 1;6(6):e2317255. doi: 10.1001/jamanetworkopen.2023.17255.

ABSTRACT

IMPORTANCE: The value to payers of robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) when compared with open radical cystectomy (ORC) for patients with bladder cancer is unclear.

OBJECTIVES: To compare the cost-effectiveness of iRARC with that of ORC.

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation used individual patient data from a randomized clinical trial at 9 surgical centers in the United Kingdom. Patients with nonmetastatic bladder cancer were recruited from March 20, 2017, to January 29, 2020. The analysis used a health service perspective and a 90-day time horizon, with supplementary analyses exploring patient benefits up to 1 year. Deterministic and probabilistic sensitivity analyses were undertaken. Data were analyzed from January 13, 2022, to March 10, 2023.

INTERVENTIONS: Patients were randomized to receive either iRARC (n = 169) or ORC (n = 169).

MAIN OUTCOMES AND MEASURES: Costs of surgery were calculated using surgery timings and equipment costs, with other hospital data based on counts of activity. Quality-adjusted life-years were calculated from European Quality of Life 5-Dimension 5-Level instrument responses. Prespecified subgroup analyses were undertaken based on patient characteristics and type of diversion.

RESULTS: A total of 305 patients with available outcome data were included in the analysis, with a mean (SD) age of 68.3 (8.1) years, and of whom 241 (79.0%) were men. Robot-assisted radical cystectomy was associated with statistically significant reductions in admissions to intensive therapy (6.35% [95% CI, 0.42%-12.28%]), and readmissions to hospital (14.56% [95% CI, 5.00%-24.11%]), but increases in theater time (31.35 [95% CI, 13.67-49.02] minutes). The additional cost of iRARC per patient was £1124 (95% CI, -£576 to £2824 [US $1622 (95% CI, -$831 to $4075)]) with an associated gain in quality-adjusted life-years of 0.01124 (95% CI, 0.00391-0.01857). The incremental cost-effectiveness ratio was £100 008 (US $144 312) per quality-adjusted life-year gained. Robot-assisted radical cystectomy had a much higher probability of being cost-effective for subgroups defined by age, tumor stage, and performance status.

CONCLUSIONS AND RELEVANCE: In this economic evaluation of surgery for patients with bladder cancer, iRARC reduced short-term morbidity and some associated costs. While the resulting cost-effectiveness ratio was in excess of thresholds used by many publicly funded health systems, patient subgroups were identified for which iRARC had a high probability of being cost-effective.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03049410.

PMID:37389878 | DOI:10.1001/jamanetworkopen.2023.17255

JAMA Netw Open. 2023 Jun 1;6(6):e2319132. doi: 10.1001/jamanetworkopen.2023.19132.

ABSTRACT

IMPORTANCE: Because type 2 diabetes (T2D) has become increasingly prevalent among young adults, the study of the association of T2D with psychiatric disorders in young adults is important for early detection and timely intervention.

OBJECTIVE: To determine whether a diagnosis of a psychiatric disorder is associated with increased risk of developing T2D in young adults.

DESIGN, SETTING, AND PARTICIPANTS: This large-scale prospective cohort study used data collected by the South Korean National Health Insurance Service between 2009 and 2012, representing 97% of the South Korean population. Young adults aged 20 to 39 years with and without diagnoses of psychiatric disorders were included in the study. Young adults with missing data and those with a history of T2D were excluded from the study. The cohort was followed up to monitor development of T2D until December 2018. Data were analyzed from March 2021 to February 2022.

EXPOSURE: Diagnosis of 1 of 5 psychiatric disorders, including schizophrenia, bipolar disorder, depressive disorder, anxiety disorder, and sleep disorder.

MAIN OUTCOMES AND MEASURES: The primary outcome was newly diagnosed T2D during a follow-up period of 7.59 years. The incidence rate of T2D was calculated as the number of new cases per 1000 person-years during the follow-up period. The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) and 95% CIs for T2D incidence. Exploratory analyses were performed for subgroups stratified by age and sex.

RESULTS: In total, 6 457 991 young adults (mean [SD] age, 30.74 [4.98] years; 3 821 858 men [59.18%]) were followed up, including 658 430 individuals with psychiatric disorders. The cumulative incidence of T2D differed significantly between individuals with and without psychiatric disorders (log-rank test, P < .001). Incidence rates of T2D for individuals with and without psychiatric disorders were 2.89 and 2.56 per 1000 person-years, respectively. Individuals with a diagnosis of any psychiatric disorder showed a higher risk of developing T2D than those without a diagnosis (adjusted HR, 1.20; 95% CI, 1.17-1.22). The adjusted HRs for T2D were 2.04 (95% CI, 1.83-2.28) for individuals with schizophrenia, 1.91 (95% CI, 1.73-2.12) for individuals with bipolar disorder, 1.24 (95% CI, 1.20-1.28) for individuals with depressive disorder, 1.13 (95% CI, 1.11-1.16) for individuals with anxiety disorder, and 1.31 (95% CI, 1.27-1.35) for individuals with sleep disorder.

CONCLUSIONS AND RELEVANCE: In this large-scale prospective cohort study of young adults, 5 psychiatric disorders were significantly associated with an increased risk of developing T2D. Young adults with schizophrenia and bipolar disorder in particular were at a higher risk of T2D. These results have important implications for early detection of and timely intervention in T2D for young adults with psychiatric disorders.

PMID:37389877 | DOI:10.1001/jamanetworkopen.2023.19132

JAMA Netw Open. 2023 Jun 1;6(6):e2321379. doi: 10.1001/jamanetworkopen.2023.21379.

ABSTRACT

IMPORTANCE: Studies in adults have demonstrated associations between arsenic exposure and clinical and subclinical cardiovascular disease (CVD). No studies to date have considered potential associations in children.

OBJECTIVE: To examine the association between total urinary arsenic levels in children and subclinical indicators of CVD.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study considered 245 children, a subset from the Environmental Exposures and Child Health Outcomes (EECHO) cohort. Children from the Syracuse, New York, metropolitan area were recruited from August 1, 2013, until November 30, 2017, with enrollment throughout the year. Statistical analysis was performed from January 1, 2022, to February 28, 2023.

EXPOSURES: Total urinary arsenic was measured using inductively coupled plasma mass spectrometry. Creatinine concentration was used to adjust for urinary dilution. In addition, potential exposure routes (eg, diet) were measured.

MAIN OUTCOMES AND MEASURES: Three indicators of subclinical CVD were assessed: carotid-femoral pulse wave velocity, carotid intima media thickness, and echocardiographic measures of cardiac remodeling.

RESULTS: The study sample included 245 children aged 9 to 11 years (mean [SD] age, 10.52 [0.93] years; 133 [54.3%] female). The geometric mean of the creatinine-adjusted total arsenic level in the population was 7.76 μg/g creatinine. After adjustment for covariates, elevated total arsenic levels were associated with significantly greater carotid intima media thickness (β = 0.21; 95% CI, 0.08-0.33; P = .001). In addition, echocardiography revealed that elevated total arsenic was significantly higher for children with concentric hypertrophy (indicated by greater left ventricular mass and greater relative wall thickness; geometric mean, 16.77 μg/g creatinine; 95% CI, 9.87-28.79 μg/g) relative to the reference group (geometric mean, 7.39 μg/g creatinine; 95% CI, 6.36-8.58 μg/g). With respect to exposure source, significant geographic clustering of total arsenic was found in 1 urban area of Syracuse, New York.

CONCLUSIONS AND RELEVANCE: These findings suggest a significant association between arsenic exposure and subclinical CVD in children. Elevated total arsenic levels were found in an area of Syracuse with known elevations of toxic metals from industrial waste, suggesting historical pollution as a possible source. Given the novelty and potential importance of this association, further research is needed to confirm our findings. Any potential effect of urinary arsenic exposure in childhood on actual clinical CVD outcomes in adulthood remains to be determined.

PMID:37389868 | DOI:10.1001/jamanetworkopen.2023.21379

J Dual Diagn. 2023 Jun 30:1-14. doi: 10.1080/15504263.2023.2225373. Online ahead of print.

ABSTRACT

Objective: The high comorbidity between posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) is well-established and complex. However, there is a need to explore transdiagnostic constructs that may underlie this association to better understand what accounts for this comorbidity and to inform treatment development. Method: Thus, the present study utilized a large, cross-sectional dataset (N = 513; M_age = 38.25 years, SD = 10.07; 49.9% female), based on national recruitment, to (1) examine whether the associations between PTSD symptom severity (PCL-5) and alcohol use severity (AUDIT) were statistically mediated by (a) anxiety sensitivity (SSASI); and (b) difficulties with emotion regulation (DERS-16); and (2) examine whether coping motives for drinking moderate this indirect effect. Sex assigned at birth was included as a covariate. Results: When examining the hypothesized mediators (SSASI and DERS-16) in separate models, there was a statistically significant indirect effect of PCL-5 on AUDIT through both SSASI and DERS. However, when both SSASI and DERS were entered into a model simultaneously, only SSASI served as a statistically significant mediator. Coping motives for drinking did not moderate the observed indirect effect. Conclusions: The current findings highlight anxiety sensitivity and emotion regulation as transdiagnostic processes that may explain, at least partially, the relationship between PTSD symptom severity and alcohol use; however, stronger evidence was evident for anxiety sensitivity. These findings may help inform the development of refined, streamlined interventions for PTSD and alcohol use that directly target these processes.

PMID:37389859 | DOI:10.1080/15504263.2023.2225373

Vector Borne Zoonotic Dis. 2023 Jun 30. doi: 10.1089/vbz.2023.0003. Online ahead of print.

ABSTRACT

Background: A total of 79 cases of dengue fever were reported in Jining County in 2017, which is currently the northernmost focal point of local cases of dengue fever diagnosed in China. This study aimed to evaluate the density of mosquito vectors before and after the outbreak of dengue fever and provide novel reference data for the prevention and control of the disease. Methods: The light traps were set to collect mosquitoes in 2017 and 2018 to assess adult mosquito density and species composition. We used the human-baited double net trap to determine the biting rate. In addition, the Breteau index (BI) was calculated to evaluate the density of Aedes albopictus in Jining, Shandong Province. The annual average densities of Ae. albopictus in 2017 and 2018 were 0.046 and 0.066 f/t/h, respectively. Results: The average biting rate was 0.69 f/m/h in 2018. There was no significant difference found in Ae. albopictus density and biting rate in the various months. The average BI of Jining was 38.67 and 11.17, respectively. There was a statistically significant difference observed in the BI between 2017 and 2018 (Kruskal-Wallis test, χ² = 16.926, df = 1, p < 0.001). Conclusion: BI can serve as an important indicator to determine the spread of dengue fever. The findings indicted that the growing density of adult Aedes mosquitoes should be focused on, with biting rates being a potential indicator of future outbreaks. Overall, the various control measures that were implemented were effective and should be introduced in other high-risk areas.

PMID:37389829 | DOI:10.1089/vbz.2023.0003

Foodborne Pathog Dis. 2023 Jun 30. doi: 10.1089/fpd.2023.0004. Online ahead of print.

ABSTRACT

The objective of this study was to conduct a systematic review to comprehensively understand antimicrobial resistance (AMR) in Listeria monocytogenes (LM) isolated from meat and meat products. The study was performed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Published articles from 2000 to 2022 were collected from six widely used online databases, including AGRICOLA, PubMed, Web of Science (WoS), Scopus, Cochrane Library, and CINAHL-EBSCO. Prevalence rates and AMR of pathogen isolates were analyzed using MedCalc software, including the I² statistic and Cochrane Q test for heterogeneity. Sensitivity analysis, subgroup analysis, and meta-regression were conducted to analyze potential sources of heterogeneity at a 95% significance level. The distribution and prevalence of multidrug resistance (MDR) were examined using a random-effect model. The pooled frequency of bacterial MDR was 22.97% (95% confidence interval [CI] = 14.95-32.13). The studies exhibited high heterogeneity (I² = 94.82%, 95% CI = 93.74-95.71, p < 0.0001). Furthermore, the most prevalent antibiotics resistance found in the majority of included studies were tetracycline, clindamycin, penicillin, ampicillin, and oxacillin (I² = 86.66%, 95% CI = 73.20-93.36, p < 0.0001). This meta-analysis provides a comprehensive understanding of AMR in LM isolates, and the results indicate that none of the variable factors, including sampling location, sampling size, or methodology, significantly influenced the outcome of LM isolates resistant to multidrug.

PMID:37389828 | DOI:10.1089/fpd.2023.0004

Blood Adv. 2023 Jun 30:bloodadvances.2023010349. doi: 10.1182/bloodadvances.2023010349. Online ahead of print.

ABSTRACT

Immunogenicity of SARS-CoV-2 vaccination is diminished in hematopoietic stem cell transplant (HSCT) recipients. To summarize current evidence and identify risk factors for attenuated responses, 5 electronic databases were searched from database inceptions through January 12, 2023, for studies reporting humoral and/or cellular immunogenicity of SARS-CoV-2 vaccination in HSCT population. Using descriptive statistics and random-effects models, extracted numbers of responders and pooled odds ratios (pORs) with 95% confidence intervals (CIs) for risk factors of negative immune responses were analyzed (PROSPERO: CRD42021277109). From 61 studies with 5,906 HSCT recipients, after 1, 2, and 3 doses of mRNA SARS-CoV-2 vaccines, the mean (95% CI) antispike antibody seropositivity rates were 38% (19-62%), 81% (77-84%), and 80% (75-84%); neutralizing antibody seropositivity rates were 52% (40-64%), 71% (54-83%), and 78% (61-89%); and cellular immune response rates were 52% (39-64%), 66% (51-79%), and 72% (52-86%). After 2 vaccine doses, risk factors (pOR; 95% CI) associated with antispike seronegativity were male recipients (0.63; 0.49-0.83), recent rituximab exposure (0.09; 0.03-0.21), haploidentical allografts (0.46; 0.22-0.95), time from HSCT <24 months (0.25; 0.07-0.89), lymphopenia (0.18; 0.13-0.24), hypogammaglobulinemia (0.23; 0.10-0.55), concomitant chemotherapy (0.48; 0.29-0.78) and immunosuppression (0.18; 0.13-0.25). Complete remission of underlying hematologic malignancy (2.55; 1.05-6.17) and myeloablative conditioning (1.72; 1.30-2.28) compared with reduced-intensity conditioning were associated with antispike seropositivity. Ongoing immunosuppression (0.31; 0.10-0.99) was associated with poor cellular immunogenicity. In conclusion, attenuated humoral and cellular immune responses to mRNA SARS-CoV-2 vaccination are associated with several risk factors among HSCT recipients. Optimizing individualized vaccination and developing alternative COVID-19 prevention strategies are warranted.

PMID:37389818 | DOI:10.1182/bloodadvances.2023010349

Int Ophthalmol. 2023 Jun 30. doi: 10.1007/s10792-023-02784-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of transepithelial accelerated crosslinking (TE-ACXL) using pulsed light and supplemental oxygen.

METHODS: Thirty eyes of 30 consecutive patients with progressive keratoconus or post-LASIK ectasia were enrolled in a prospective non-comparative study conducted at the Magrabi Eye Center (Jeddah, Saudi Arabia). All eyes underwent TE-ACXL with supplemental oxygen. Primary outcome measures were the mean change in corrected distance visual acuity (CDVA) (logMAR) and maximum keratometry (max K) from preoperatively to 12 months postoperatively. Secondary outcome measures included change in manifest refractive spherical equivalent (MRSE), refractive cylinder, keratometry, symmetry index (SI), center-surrounding index (CSI) and ectasia index (EI) of the anterior and posterior corneal surfaces, corneal and epithelial thickness at corneal vertex and thinnest location, corneal densitometry, corneal high order aberrations (HOA) and endothelial cell density (ECD).

RESULTS: Mean age was 29.6 ± 8.2 years. At 1 year, the follow up rate was 93.3%. CDVA improved statistically significantly at 12 months (p = 0.027). Measures of corneal keratometry or pachymetry did not change significantly (p < 0.05). Postoperatively, a demarcation line was documented in 78.6% eyes at 1 month, and in 12 (42.9%) eyes at 12 months. The mean depth of the demarcation line was 341.9 ± 49.4 µm. Corneal densitometry increased significantly at 1- and 3-months (p < 0.05) and returned to normal levels at 6- and 12-months postoperatively.

CONCLUSION: TE-ACXL with oxygen supplement is effective at halting the progression of corneal ectasia for at least 1 year and can be a refractive neutral procedure.

PMID:37389763 | DOI:10.1007/s10792-023-02784-1

Qual Life Res. 2023 Jun 30. doi: 10.1007/s11136-023-03460-8. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate associations between quality of life (QoL) and 1) immunotherapy and other cancer treatments received three months before QoL measurements, and 2) the comorbidities at the time of completion or in the year prior to QoL measurements, among patients with advanced cancer.

METHODS: A cross-sectional study is conducted on patients with advanced cancer in the Netherlands. The data come from the baseline wave of the 2017-2020 eQuiPe study. Participants were surveyed via questionnaires (including EORTC QLQ-C30). Using multivariable linear and logistic regression models, we explored statistical associations between QoL components and immunotherapy and other cancer treatments as well as pre-existing comorbidities while adjusting for age, sex, socio-economic status.

RESULTS: Of 1088 participants with median age 67 years, 51% were men. Immunotherapy was not associated with global QoL but was associated with reduced appetite loss (odds ratio (OR) = 0.6, 95%CI = [0.3,0.9]). Reduced global QoL was associated with chemotherapy (adjusted mean difference (β) = – 4.7, 95% CI [- 8.5,- 0.8]), back pain (β = – 7.4, 95% CI [- 11.0,- 3.8]), depression (β = – 13.8, 95% CI [- 21.5,- 6.2]), thyroid diseases (β = – 8.9, 95% CI [- 14.0,- 3.8]) and diabetes (β = – 4.5, 95% CI [- 8.9,- 0.5]). Chemotherapy was associated with lower physical (OR = 2.4, 95% CI [1.5,3.9]) and role (OR = 1.8, 95% CI [1.2,2.7]) functioning, and higher pain (OR = 1.9, 95% CI [1.3,2.9]) and fatigue (OR = 1.6, 95% CI [1.1,2.4]).

CONCLUSION: Our study identified associations between specific cancer treatments, lower QoL and more symptoms. Monitoring symptoms may improve QoL of patients with advanced cancer. Producing more evidence from real life data would help physicians in better identifying patients who require additional supportive care.

PMID:37389733 | DOI:10.1007/s11136-023-03460-8